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Select Drug Program® Formulary updates

June 1, 2015

The Select Drug Program Formulary, which is available for commercial members, is a list of medications approved by the U.S. Food and Drug Administration that were chosen for formulary coverage based on their medical effectiveness, safety, and value. The list changes periodically as the Pharmacy and Therapeutics Committee reviews the formulary to ensure its continued effectiveness. The most recent changes are listed below.

Generic additions

These generic drugs recently became available in the marketplace. When these generic drugs became available, we began covering them at the appropriate generic formulary level of cost-sharing:

Generic drug Brand drug Formulary chapter Effective date
amlodipine-valsartan-HCTZ Exforge HCT® 4. Heart, Blood Pressure, & Cholesterol December 8, 2014
celecoxib Celebrex® 3. Pain, Nervous System, & Psych December 15, 2014
clobetasol propionate spray Clobex® Spray 5. Skin Medications January 5, 2015
colchicineColcrys® 9. Bone, Joint, & Muscle January 19, 2015
colchicineMitigare? 9. Bone, Joint, & Muscle January 19, 2015
dexmethylphenidate ERFocalin XR® 3. Pain, Nervous System, & PsychNovember 17, 2015
estradiolVivelle-Dot® 10. Female, Hormone Replacement, & Birth Control December 29, 2014
guanfacine ER* Intuniv? 3. Pain, Nervous System, & Psych December 8, 2014
ivermectin Stromectol® 1. Antibiotics & Other Drugs Used for InfectionNovember 17, 2014
lamivudine sol Epivir® Sol 1. Antibiotics & Other Drugs Used for Infection January 12, 2015
MB hydrogel Aurstat® 5. Skin Medications December 8, 2014
mycophenolate mofetil susp Cellcept® Susp 2. Cancer & Organ Transplant Drugs November 24, 2014
prednisolone sodium phosphate Orapred ODT® 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones December 15, 2014
sirolimus 1 mg, 2 mg tabs Rapamune® 1 mg, 2 mg tabs 2. Cancer & Organ Transplant Drugs November 3, 2014
tacrolimus Protopic® 2. Cancer & Organ Transplant Drugs December 1, 2014
testosterone 1% packet* Androgel® 1% Packet 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones January 5, 2015
Urea 47% cream Keralac® 47% Cream 5. Skin Medications December 1, 2014
Uro-L Urelle® 1. Antibiotics & Other Drugs Used for Infection December 29, 2014
Uro-MP Uribel1. Antibiotics & Other Drugs Used for Infection December 22, 2014
valganciclovir Valcyte® 1. Antibiotics & Other Drugs Used for Infection December 8, 2014

*Generic requires prior authorization.

Brand additions

These brand drugs were added to the formulary as of the date indicated below and are covered at the appropriate brand formulary level of cost-sharing:

Brand drugGeneric drugFormulary chapter Effective date
Harvoni® Not available 1. Antibiotics & Other Drugs Used for Infection April 1, 2015
Invokamet® Not available 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones June 1, 2015
Invokana® Not available 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones June 1, 2015
Suboxone® Film* Not available 3. Pain, Nervous System, & Psych June 1, 2015

*Covered at the appropriate generic formulary level of cost-sharing.

Brand deletions

Effective July 1, 2015, these brand drugs will be covered at the appropriate non-formulary level of cost-sharing:

Brand drugGeneric drugFormulary chapter
Androgel® 1% Packet testosterone 1% packet 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
Celebrex® celecoxib 3. Pain, Nervous System, & Psych
Cellcept® Susp mycophenolate mofetil susp 2. Cancer & Organ Transplant Drugs
Clobex® Spray clobetasol propionate spray 5. Skin Medications
Colcrys® colchicine9. Bone, Joint, & Muscle
Rapamune® 1 mg, 2 mg tabs sirolimus 1 mg, 2 mg tabs 2. Cancer & Organ Transplant Drugs
Valcyte® valganciclovir 1. Antibiotics & Other Drugs Used for Infection
Vivelle-Dot® estradiol 10. Female, Hormone Replacement, & Birth Control

The generic drugs for the above brand drugs are on our formulary and available at the generic formulary level of cost-sharing.

Effective July 1, 2015, Effective July 1, 2015, this brand drug will be covered at the appropriate non-formulary level of cost-sharing:

Brand drugGeneric drugFormulary chapter
Blephamide® Susp sulfacetamide/prednisolone susp 11. Eye Medications

There is no generic equivalent for the above brand drug; however, there is a formulary therapeutic alternative drug. This therapeutic alternative drug is available at the appropriate formulary level of cost-sharing. We encourage you to discuss formulary alternatives with your patients.


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